An exercise in vitriol rather than sound journalism

Gary Taubes from the March 2003 issue

(Page 6 of 7)

There is a tendency for students, and indeed many clinicians, to treat the medical literature with undue respect. Major journals such as the Lancet and the New England Journal of Medicine are presumed to present new medical facts which are not to be disputed. Such a naïve faith in the "clinical gospels" is perhaps encouraged by the dogmatic style that many authors adopt, so that the uncertainties inherent in any research project often receive inadequate emphasis.

In this case, the inadequate emphasis is communicated by ignoring the fact that the NWCR is completely uncontrolled. Fumento does point this out, but then he decides it's irrelevant. He quotes Suzanne Phelan, a Brown University NWCR co-investigator saying, "you cannot get around the problem" that people who sign up for the NWCR are self-selected. Phelan is right. You can't. As a result, the NWCR is no more than an uncontrolled exercise in data collection. The only reliable statement that can be made from the NWCR data is that some 3000 individuals out of the tens of millions each year who try to lose weight, said they succeeded by reducing the fat and calories in their diet and maybe by exercising, as well. That's a nice factoid, but it adds excruciatingly little to the relevant science.

Fumento then rightfully asks why low-carb dieters do not appear in the NWCR. That's a good question and one worth investigating. This is of particular interest considering, for instance, the May 2002 issue of Consumer Reports. CR queried their readers and came up with 8000 who reported that they lost ten percent of their body weight and kept it off for at least a year --including 4000 "super losers" who lost an average of 37 pounds. According to CR, the number one lesson learned from these successful dieters was the need to "tame your blood sugar" and to do so by eating less carbohydrates and particularly less refined carbohydrates and starches. Now this is no scientific survey, but it is no less scientific, regrettably, than the National Weight Control Registry.

Fumento then raises the question of whether low carb diets might suppress hunger. He invokes as evidence that there is no "empirical support for this" an April 2002 review in the Journal of the American College of Nutrition. This is leg number three of his tripodal "crushing" mass of evidence. The JACN article, reports Fumento, reviewed high and low fat treatments when subjects were allowed to eat as much as they wanted, and found that "energy intake on the low-fat diets ranged from 16 percent to 24 percent less than those on high fat diets."

This time Fumento gets the issue date of the article correct, but he incomprehensibly butchers the quote. The relevant quote actually reads "energy intakes on the low fat diets averaged 71 percent (10 days to 2 months) to 84 percent (1-9 days) of intakes on the control higher fat regimes."

Either way, this is an interesting finding but irrelevant. It says nothing about why individuals on low carbohydrate diets or very low carbohydrate diets like Atkins's, as even Fumento reports to be the case, lose considerable weight, and why they apparently find it relatively easy to restrict their calories to do so. Fumento turns to Penn State nutritionist Barbara Rolls on this subject and describes her as "widely considered the nation's top authority on satiety", which is a lovely compliment but a bit of a stretch. Rolls invokes studies in which she and her colleagues infused pure fat and pure carbs into their subjects and found very little difference in subsequent short-term satiety. These experiments, however, say precious little about whether the macronutrient content of the diet would have an impact on the kind of weight loss or gain that takes place in real life and over periods of months or years, not hours. Both Fumento and Rolls, if her opinions are represented accurately, confuse evidence with proof.

It is worth remarking, which Fumento did not, that the sentence in the JACN review that followed his misquote made this point: "it is interesting to note that the changes in body weight observed in the low fat intervention studies are small in absolute terms (0.7 kg-1.0 kg in short-term and long-term studies on average) and also appear small compared to the changes in energy intake." For those, perhaps like Fumento, who might not be expected to read these articles carefully, this was included as one of five "teaching points" of the JACN review: "low fat dietary intervention studies have resulted in small weight loss--less than 1 kg on average in studies of up to one year's duration."

Fumento's next assault on my reporting is to accuse me of not being able to extract a single useful line from five other "top obesity researchers." One of these, however, Xavier Pi-Sunyer, I did not interview for this story. One of them, Marion Nestle, is a nutritionist and administrator with a background in molecular biology. She is not and never has been an obesity researcher, nor has she ever treated obese patients. One of them, Arne Astrup, co-authored with Hill the December 2000 International Journal of Obesity and Related Metabolic Disorders meta-analysis. My earlier comments about meta-analyses and controlled trials would suggest why I might have shied away from quoting Astrup for the enlightenment of my readers. And one of them, Jules Hirsch of Rockefeller University, I did quote in early drafts of my article, but the relevant paragraphs, regrettably, were among the last to be cut for space reasons. First it quoted Hirsch saying "Of all the damn unsuccessful treatments, the treatment of weight reduction by diet for obese people just doesn't seem to work. " It then continued:

This has led Hirsch, for example, into such a state of frustration that when we spoke last March, he said he could no more explain how obese individuals could lose weight, then he could explain how they gained it to begin with. "I've been working on this since 1960," he said. "That's a hell of a long time. You think I would have gotten a little farther along with it." For the last 20 years, Hirsch has worked with Rudy Leibel on some of the seminal experiments in obesity research. When I interviewed Leibel, who is now at Columbia University, he capped our conversation this way: "if you do feel you understand this," he said, "it will probably indicate that you've lost your mind."

I hated to see it go.

Fumento moves next to the subject of glycemic index, which is a measure of the effect of carbohydrates on blood sugar and insulin secretion. My article suggested that the glycemic index concept might be relevant to the question of why we gain weight so easily and have such trouble losing it. Fumento first mangles his explanation of the concept, and then dispenses with it as thoroughly irrelevant to the scientific discussion at hand.

The gist of the glycemic index idea, is that the more easily digested the carbohydrates, the quicker and more dramatic their effect on blood sugar and the greater the resulting secretion of insulin. These effects, so the hypothesis goes, might then have some long-term effect on hunger and fat deposition and eventually on weight. Carbohydrates--such as sugar, white bread or potatoes--have a high glycemic index and are absorbed into the blood stream quickly. Those with a low glycemic index, such as whole grains, are absorbed more slowly.

As to its relevance, it was this glycemic index concept that Consumer Reports had in mind when it advocated "taming your blood sugar" to lose weight. Curiously enough the same April 2002 Journal of the American College of Nutrition review that Fumento misquoted, also discussed the evidence that the glycemic index of carbohydrates could have relevance to hunger, food intake and weight, although Fumento missed this, as well, or ignored it. This point, too, made it into one of the five teaching points; ""short-term studies suggest that low-glycemic index carbohydrates suppress hunger more effectively than high glycemic index carbohydrates, but there are no long-term intervention studies to examine the effects of lowering the glycemic index on body weight."

Moving toward his finale, Fumento returns back to the Atkins diet and the question of whether it is safe for the long term. He cites the five unpublished trials and says they are evidence that the diet might not be "as harmful as was once generally believed" but then says the natures of the fats involved in the diet are "a distinction Taubes decided to lose." Wrong again. To be precise I discussed the effects of the fats on the various cholesterol and fatty acid particles in the blood, which, short of an actual heart attack, is the end result of interest.

I said "In all five studies, cholesterol levels improved similarly with both diets, but triglyceride levels were considerably lower with the Atkins diet. Though researchers are hesitant to agree with this, it does suggest that heart-disease risk could actually be reduced when fat is added back into the diet and starches and refined carbohydrates are removed." I then went on to describe the studies that were in the works to extend this result and see if it would be sustained over longer time periods, and I discussed my own anxiety eating such a diet that included, in my case, eggs and sausage every morning. "I can look down at my eggs and sausage" I wrote, "and still imagine the imminent onset of heart disease and obesity, the latter assuredly to be caused by some bizarre rebound phenomena the likes of which science has not yet begun to describe. The fact that Atkins himself has had heart trouble recently does not ease my anxiety, despite his assurance that it is not diet-related."

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|10.22.09 @ 3:56PM|#

Having read all three pieces in this debate, Fumento's critique of Taubes is so wholly inadequate I feel embarassed for him, and disappointed that Reason didn't vet Fumento seriously before publishing his original critique of Taubes. Taubes' position is increasingly permeating the research community and will likely be vindicated, leaving Fumento's piece as an embarassing example of Reason failing its mandate to provide critical analysis of contemporary debates. Reason's standards should be higher than merely being a forum for dissent -- you should have some standards for the dissent, and recognize dogmatic clinging to establishment thinking when you see it. The sooner the Lipid Hypothesis dies and refined carbs are recognized for their negative health effects the better the health of the world. We owe Taubes a serious debt of thanks for his integtrity and iconoclastic pursuit of reason. He shouldn't have had to offer this defense, likely only read by a fraction of those who read the original critique.

|1.30.10 @ 8:02PM|#

Great response. I'm disappointed that Reason didn't recognize expert-led dogma dished out by Fumento

Pingback| 2.5.10 @ 7:05PM

Karen De Coster » Primal Life: A Journey of Diet and Health links to this page. Here’s an excerpt:

…Times: “ Michael Pollan Offers 64 Ways to Eat Food ” MIT: “ Inside the Story: Gary Taubes Interview ” Testosterone Muscle: Interview With Gary Taubes Reason Magazine (Gary Taubes): “ An Exercise in Vitriol Rather Than Sound Journalism ” New York Times: “ The New Age Cavemen and the City ” Gary Taubes: “ The Soft Science of Dietary Fat ” LewRockwell.com (Dr. Donald Miller): “ Iodine for Health ” Products YouBar La…

|5.19.10 @ 9:49PM|#

Taubes writes, "Regrettably, Fumento doesn't seem to understand the critical point, and perhaps even the less critical points, and so makes us both look like idiots." Reminds me of the Rabbi's advice: "Never argue with a fool - passersby won't know who's who."

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|1.21.11 @ 7:13AM|#

I am very interested in this debate. Undoubtedly, the calories in, calories out hypothesis that I was taught (my physiology professor said only calories mattered - you could eat only butter and you wouldn't weigh anymore if you ate 2,000 calories from lettice or butter).
I think as biology advances, and it is understood that fat cells are not nearly the passive recepticles of "excess calories" that they were once thought to be, it will become to understood that what you eat matters for some percentage of the poplulation.
Also, one thing that has to be understood is that we all differ. Some people can eat, eat, eat and not gain weight. Some people are sensitive to carbs, and some aren't.
My own experience of going on a low carbohydrate diet was very salutory - I lost weight, my triglycerides decreased as well as my LDL cholesterol.

|3.12.11 @ 3:53AM|#

Is it possible to get a small concise article near the front page of either Vancouver BC newspaper. It should include Dr Wortman, Alert Bay, G&B Carbs and possibly Valemount? I so need help with an argument.

Dav|3.21.12 @ 2:23PM|#

Excellent reply from Gary

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